<link rel="stylesheet" href="{{ getAssets }}css/opt.css?v={{ assets_version }}">
<div class="widget am-cf">
    <div class="widget-head am-cf">
        <div class="widget-title  am-fl">验光</div>
        <div class="widget-function am-fr">
             <!--<a href='{{urlfor "ArchivesController.Edit"}}/0' class="am-btn am-btn-default am-btn-warning" id="swipe_card"><span class="am-icon-thumb-tack"></span> 查询客户</a>-->
        </div>	
    </div>
    <div class="widget-body  am-fr">
        <form class="am-form query-form" data-am-validator id="formDoSubmitThis" {{if .m.Id}} reback='{{urlfor "OptometryController.Index"}}'{{else}} reback='{{urlfor "OptometryController.Edit"}}'{{end}}>
            <input type="hidden" name="arch_id" id="arch_id" value="0">
            <div class="row am-cf">

              <div class="am-form-group am-input-group-sm am-u-sm-12 am-u-md-6 am-u-lg-4">
                  <label class="am-u-sm-3 am-form-label">姓名：</label>
                  <div class="am-u-sm-9">
                       <input name="Realname" type="text" id="Realname" class="am-input-sm"  placeholder="长度不超过20" maxlength="20" readonly required/>
                   </div> 
              </div>
              <div class="am-form-group am-u-sm-12 am-u-md-6 am-u-lg-4">
                <label class="am-u-sm-3 am-form-label">手机：</label>
                <div class="am-u-sm-9">
                        <input type="text" class="am-form-field am-input-sm" id="Mobile" name="Mobile" value="" placeholder="输入手机号" readonly required>
                </div>
              </div>
              <div class="am-form-group am-input-group-sm am-u-sm-12 am-u-md-6 am-u-lg-4">
                  <label class="am-u-sm-3 am-form-label">性别：</label>
                  <div class="am-u-sm-9">
                          <label class="am-radio-inline">
                            <input type="radio"  name="Sex" value="男" required data-am-ucheck> 男
                          </label>
                          <label class="am-radio-inline">
                            <input type="radio" name="Sex" value="女" data-am-ucheck> 女
                          </label>
                   </div> 
              </div>
          </div>    

            <div class="row am-cf">
                  
                  <div class="am-form-group am-input-group-sm am-u-sm-12 am-u-md-6 am-u-lg-4">
                      <label class="am-u-sm-3 am-form-label">医生：</label>
                      <div class="am-u-sm-9">
                           <select data-am-selected="{searchBox: 1}" class="am-input-sm" name="Doctor" id="Doctor"  style="display: none;" required>
                            {{range $k, $v := .c.doctor}}
                                <option value="{{$v.OptionName}}">{{$v.Pinyin}} | {{$v.OptionName}}</option>
                            {{end}}
                           </select>
                       </div> 
                  </div>
    
                  <div class="am-form-group am-input-group-sm am-u-sm-12 am-u-md-6 am-u-lg-4">
                      <label class="am-u-sm-3 am-form-label">验光师：</label>
                      <div class="am-u-sm-9">
                            <select data-am-selected="{searchBox: 1}" class="am-input-sm" name="Optometrist" id="Optometrist"  style="display: none;" required>
                                {{range $k, $v := .c.optometrist}}
                                    <option value="{{$v.OptionName}}">{{$v.Pinyin}} | {{$v.OptionName}}</option>
                                {{end}}
                            </select>
                       </div> 
                  </div>
                  <div class="am-form-group am-u-sm-12 am-u-md-6 am-u-lg-4">
                      <label class="am-u-sm-3 am-form-label">备注：</label>
                      <div class="am-u-sm-9">
                          <input name="remarks" type="text" id="remarks" class="am-input-sm"  />
                       </div> 
                  </div>
            </div>
            <style>.am-table td{ text-align:center;}.am-table input{ text-align:center;}</style>
            <div class="row am-cf">
                <div class="am-form-group am-input-group-sm am-u-sm-12">
                    <div id="chufang_info">
                        <div class="chufang">
                    <div class="title am-cf">
                        <h3>处方</h3>
                        <ul class="tab-lei am-cf">
                            <li><a class="active" data-type="far" href="javascript:void(0);">远用处方</a></li>
                            <li><a data-type="near" href="javascript:void(0);">近用处方</a></li>
                            <!--<li><a data-type="yinxing" href="javascript:void(0);">隐形处方</a></li>-->
                            <!--<li><a data-type="duojiaodian" href="javascript:void(0);">多焦点处方</a></li>-->
                        </ul>
                    </div>
                    <div class="datatable-shili" data-type="far" saved="fales">
                        <div class="info-bar list-head am-cf" >
                            <div class="item" style="width:11%">球镜</div>
                            <div class="item" style="width:11%">柱镜</div>
                            <div class="item" style="width:11%">轴位</div>
                            <div class="item" style="width:11%">瞳距(mm)</div>
                            <div class="item" style="width:11%">瞳高(mm)</div>
                            <div class="item" style="width:11%">裸眼视力</div>
                            <div class="item" style="width:11%">矫正视力</div>
                            <div class="item" style="width:11%">棱镜</div>
                            <div class="item" style="width:11%">基底</div>
                        </div>
                        <div class="info-bar blue-bg am-cf" data-type="right">
                            <div class="item" data-type="sph" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="cyl" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="axial_view" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="pd_yuan" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="mrp" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="nv" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="cv" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="v" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="bc" style="width:11%" contenteditable="true"></div>
                            <span class="type blue">右眼</span>
                        </div>
                        <div class="info-bar red-bg am-cf" data-type="left">
                            <div class="item" data-type="sph" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="cyl" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="axial_view" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="pd_yuan" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="mrp" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="nv" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="cv" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="v" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="bc" style="width:11%" contenteditable="true"></div>
                            <span class="type red" contenteditable="true">左眼</span>
                        </div>
                        <div class="info-bar define-row col4 am-cf">
                            <div class="item"><div class="pmr" data-type="total_pd_yuan"><span>总远用瞳距:</span><b></b>mm</div></div>
                        </div>
                        <a class="clear-btn" href="javascript:void(0);"><i class="am-icon-trash-o"></i>清除</a>
                    </div>
                    <div class="datatable-shili" data-type="near" saved="fales" style="display:none;">
                        <div class="info-bar list-head am-cf"  >
                            <div class="item" style="width:11%">球镜</div>
                            <div class="item" style="width:11%">柱镜</div>
                            <div class="item" style="width:11%">轴位</div>
                            <div class="item" style="width:11%">瞳距(mm)</div>
                            <div class="item" style="width:11%">瞳高(mm)</div>
                            <div class="item" style="width:11%">裸眼视力</div>
                            <div class="item" style="width:11%">矫正视力</div>
                            <div class="item" style="width:11%">棱镜</div>
                            <div class="item" style="width:11%">基底</div>
                        </div>
                        <div class="info-bar blue-bg am-cf" data-type="right">
                            <div class="item" data-type="sph" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="cyl" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="axial_view" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="pd_jin" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="mrp" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="nv" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="cv" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="v" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="bc" style="width:11%" contenteditable="true"></div>
                            <span class="type blue">右眼</span>
                        </div>
                        <div class="info-bar red-bg am-cf" data-type="left">
                            <div class="item" data-type="sph" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="cyl" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="axial_view" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="pd_jin" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="mrp" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="nv" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="cv" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="v" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="bc" style="width:11%" contenteditable="true"></div>
                            <span class="type red">左眼</span>
                        </div>
                        <div class="info-bar define-row col4 am-cf">
                            <div class="item"><div class="pmr" data-type="total_pd_jin"><span>总近用瞳距:</span><b></b>mm</div></div>
                        </div>
                        <a class="clear-btn" href="javascript:void(0);"><i class="am-icon-trash-o"></i>清除</a>
                    </div>
                    <div class="datatable-shili" data-type="yinxing" saved="fales" style="display:none;">
                        <div class="info-bar list-head am-cf"  >
                            <div class="item" style="width:11%">球镜</div>
                            <div class="item" style="width:11%">柱镜</div>
                            <div class="item" style="width:11%">轴位</div>
                            <div class="item" style="width:11%">瞳距(mm)</div>
                            <div class="item" style="width:11%">瞳高(mm)</div>
                            <div class="item" style="width:11%">裸眼视力</div>
                            <div class="item" style="width:11%">矫正视力</div>
                            <div class="item" style="width:11%">直径</div>
                            <div class="item" style="width:11%">基弧</div>
                        </div>
                        <div class="info-bar blue-bg am-cf" data-type="right">
                            <div class="item" data-type="sph" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="cyl" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="axial_view" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="pd_jin" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="mrp" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="nv" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="cv" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="diameter" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="base_curve" style="width:11%" contenteditable="true"></div>
                            <span class="type blue">右眼</span>
                        </div>
                        <div class="info-bar red-bg am-cf" data-type="left">
                            <div class="item" data-type="sph" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="cyl" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="axial_view" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="pd_jin" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="mrp" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="nv" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="cv" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="diameter" style="width:11%" contenteditable="true"></div>
                            <div class="item" data-type="base_curve" style="width:11%" contenteditable="true"></div>
                            <span class="type red">左眼</span>
                        </div>
                        <a class="clear-btn" href="javascript:void(0);"><i class="am-icon-trash-o"></i>清除</a>
                    </div>
                    <div class="datatable-shili" data-type="duojiaodian" saved="fales" style="display:none;">
                        <div class="info-bar list-head am-cf" >
                            <div class="item" style="width:8.3%">球镜</div>
                            <div class="item" style="width:8.3%">柱镜</div>
                            <div class="item" style="width:8.3%">轴位</div>
                            <div class="item" style="width:8.3%">近瞳距(mm)</div>
                            <div class="item" style="width:8.3%">远瞳距(mm)</div>
                            <div class="item" style="width:8.3%">瞳高(mm)</div>
                            <div class="item" style="width:8.3%">裸眼视力</div>
                            <div class="item" style="width:8.3%">矫正视力</div>
                            <div class="item" style="width:8.3%">ADD</div>
                            <div class="item" style="width:8.3%">通道</div>
                            <div class="item" style="width:8.3%">棱镜</div>
                            <div class="item" style="width:8.3%">基底</div>
                        </div>
                        <div class="info-bar blue-bg am-cf" data-type="right">
                            <div class="item" data-type="sph" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="cyl" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="axial_view" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="pd_jin" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="pd_yuan" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="mrp" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="nv" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="cv" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="add_info" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="pass" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="v" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="bc" style="width:8.3%" contenteditable="true"></div>
                            <span class="type blue">右眼</span>
                        </div>
                        <div class="info-bar red-bg am-cf" data-type="left">
                            <div class="item" data-type="sph" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="cyl" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="axial_view" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="pd_jin" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="pd_yuan" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="mrp" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="nv" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="cv" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="add_info" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="pass" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="v" style="width:8.3%" contenteditable="true"></div>
                            <div class="item" data-type="bc" style="width:8.3%" contenteditable="true"></div>
                            <span class="type red">左眼</span>
                        </div>
                        <div class="info-bar define-row col4 am-cf">
                            <div class="item"><div class="pmr" data-type="total_pd_jin"><span>总近用瞳距:</span><b></b>mm</div></div>
                            <div class="item"><div class="pmr" data-type="total_pd_yuan"><span>总远用瞳距:</span><b></b>mm</div></div>
                        </div>
                        <a class="clear-btn" href="javascript:void(0);"><i class="am-icon-trash-o"></i>清除</a>
                    </div>
                </div>
            </div>
                </div>
            </div>

          <div class="am-form-group am-u-sm-12 am-u-md-12 am-text-center">
               <button class="am-btn am-btn-secondary" type="button" id="submit_btn">确认提交</button>
             <button class="am-btn am-btn-default" type="reset">重置</button>
          </div>
         
        </form>
  </div>
</div>